Tuesday, April 21, 2009
Bone density is not the only key to osteoporosis
Dr. Michael Camardi
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About Dr. Michael Camardi
Dr. Michael Camardi is a geriatrician at Carilion's Center for Healthy Aging. Age Matters is his new Roanoke Times column, appearing the third Tuesday of every month.
Camardi has been with Carilion for about three years and was one of the experts who reporter Beth Macy spoke to for her series, “Age of Uncertainty.” He wanted to start this column to help answer questions he’s often heard as part of his job.
Camardi was founder and past medical director of the geriatric liaison program for Jacobi Medical Center (Albert Einstein College of Medicine) in Bronx, N .Y.
Camardi trained at Winthrop University Hospital (Stony Brook University Medical School), where he was chief medical resident. He has received numerous commendations for his contributions to education, patient advocacy, community relations and hospital administration.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014, or e-mail them to extra@roanoke.com with “Age Matters” in the subject line.
Dear Dr. Camardi: I was so pleased at how you and your team took care of my mother while she was recovering from a broken hip at Spring Tree Rehabilitation Center that I wanted to write and thank you. You always gave her a smile and made her feel hopeful.
I also wanted to ask you if you could repeat what you were talking about to all those people when you were examining Mother about osteoporosis because I have it, too, and it sounded interesting. Thank you.
-- Roanoke
Thank you for the opportunity to discuss this very important topic.
My interest in this field started back in the mid-1990s when we at Jacobi Medical Center in New York became one of the first centers to start work with a new, at that time, diagnostic tool called a DEXA scan, with which we could begin to identify patients who might benefit from osteoporosis treatment.
At the time, we noticed the difference in the appearance of bones from a routine chest X-ray among females from different parts of the world. It led us to start looking at the variances in bone mineral density based on ethnicity and how to tailor some early approaches to suit such diversity.
We found that ethnicity played an important role in bone health. The lasting impression I had from that work was that on its own, bone density is not really the Holy Grail of osteoporosis.
For years, I struggled with how to identify those patients who truly need treatment and when to begin such treatment.
Recently the World Health Organization presented a methodology called the FRAX (or "fracture") assessment calculator that incorporated our early and very basic work with many others from around the world in trying to understand the role of ethnicity in gauging osteoporosis risk, as well as what to do with the gray area of osteopenia.
Now we have a method for understanding both and the key for the use of this tool is getting a DEXA scan. Timing of the test is important because many women can wait until the age of 65 unless:
- there is a family history of osteoporosis,
- they are Caucasian or Asian,
- they have a small frame,
- they take certain medications (check with your provider),
- they have broken a bone as an adult,
- or they have certain conditions that can raise the chances of getting the disease such as multiple sclerosis or inflammatory conditions of the bowel, in which case one should be studied at age 50 or older.
Once you get the DEXA scan, sometimes you get a result called osteopenia, which puts you in a gray zone of thinning bones but not quite osteoporosis. This is where the FRAX calculation comes in, because if you have osteopenia and a 10-year fracture risk above 18 percent to 20 percent, then you should start taking medications sooner.
One more item. A study from Tufts University demonstrated that women who did strength training twice a week for a year gained about 1 percent to 2 percent in bone density, but they lost the gains if they stopped it.
This contradicts the current dogma that a woman's skeleton is formed mostly in adolescence and young adulthood, and that a lack of estrogen after menopause greatly speeds the bones' decline.
Any weight-bearing workout can provide similar benefits. The key: Keep increasing the intensity with the aid of a good strength trainer who understands your goals.
Along with this, realize that while food alone cannot build bone density, a diet rich in calcium and vitamin D can slow the rate of bone loss. In the March 23 issue of The Archives of Internal Medicine, a study reviewed trials that included more than 65,000 subjects.
It found that vitamin D doses less than 400 international units a day had no important effect in preventing nonvertebral bone fractures, but for doses larger than that, the data showed a 20 percent reduction in the risk for all nonvertebral fractures, and an 18 percent reduction for broken hips.
The type of vitamin D also was important. Without getting too technical, there are different types of vitamin D (vitamin D2 and D3). The effect of vitamin D3 was significant, with a 23 percent risk reduction, but there was no significant reduction with vitamin D2.
Be sure to check with your provider on how to bring these factors safely into your healthy lifestyle choices .
By the way, no, gentlemen, I did not forget you, but you are the topic of another article.
Over the years, all of this has been very interesting to me because in my field of work, I just think about how much pain could have been avoided, bones saved and complications curtailed if we started treatments sooner and patients started helping themselves at a younger age.
Just the saving in global health care costs would be incredible.
While it has been a long time in coming, I now feel we have a strategy based on data to improve our chances at a better outcome for people so that my geriatric patients can enjoy fewer days in the hospital and more days in the sunshine with their families.
Dr. Michael Camardi is a geriatrician at the Carilion Center for Healthy Aging. His columns run on the third Tuesday of each month in Extra.
If you have questions for Camardi, please mail them to him at Center for Healthy Aging, 2118 Rosalind Ave., Roanoke, VA 24014 or e-mail them to extra@roanoke.com with "Age Matters" in the subject line.
